Endoscopic instrument

ABSTRACT

An endoscopic instrument ( 1, 134 ), for inserting into a body of a patient, includes a tubular shank ( 3, 47, 137 ) which is coupled or can be coupled to a handling device ( 5, 135 ) and is with a working channel ( 15 ). A shank tool can be led through the working channel ( 15 ). The working channel ( 15 ) includes a proximal working channel opening ( 153 ) for inserting the shank tool and a fluid inlet ( 148 ) which is separate from the proximal working channel opening.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a United States National Phase Application ofInternational Application PCT/DE2019/200130, filed Nov. 7, 2019, andclaims the benefit of priority under 35 U.S.C. § 119 of GermanApplication 10 2018 218 954.4, filed Nov. 7, 2018, the entire contentsof which are incorporated herein by reference.

TECHNICAL FIELD

The disclosure relates to an endoscopic instrument for inserting into abody of a patient, preferably as a disposable article for disposal afterusing once and preferably for the minimal-invasive diagnosis of kidneytubes and ureters as well as for the removal of kidney and urinarystones.

TECHNICAL BACKGROUND

The starting point of the invention are uretero-renoscopes as are knownfor instance from EP 2 986 237 B1. A shank of the uretero-renoscope isinserted into the body of a patient via the ureter, in order with adistal gripping means such as for instance a capture basket or a Dormialoop, to capture a kidney stone or a urinary stone and to remove it.Such uretero-renoscopes however can not only be used therapeutically,but also merely diagnostically, since the treating person can herewithview and diagnose the kidney tube or ureter in a direct manner. Usually,the visibility is improved by rinsing fluid which at the distal end ofthe shank exits through a rinsing conduit which is led through theshank, and carries along tissue which inhibits the view.

There is the constant desire to reduce the shank diameter of suchinstruments, in order to fashion the medical operation in a minimalinvasive manner as much as possible or to better utilize the crosssection which is available, in order to be able to provide more orimproved functionalities given the same cross section.

SUMMARY

The endoscopic instrument which is disclosed herein can be configuredwith a smaller shank diameter than known endoscopic instruments of thistype or utilizes the cross section which is available to a betterextent, in order given the same cross section to be able to provide moreor improved functionalities.

According to an aspect of the present disclosure, an endoscopicinstrument for inserting into a body of a patent is provided, whereinthe instrument comprises a tubular shank which is coupled or can becoupled to a handling device and is with a working channel, wherein ashank tool, for example a capture basket insert or a forceps instrumentcan be led through the working channel. The working channel hereincomprises a proximal working channel opening for inserting a shank tool,and a fluid inlet which is separate from the proximal working channelopening. By way of this, the working channel can be used as a feedchannel for rinsing fluid even given an inserted shank tool.

Optionally, the proximal working channel opening and the fluid inlet canbe connected to the working channel via a T-connection piece in thehandling device. The T-connection piece is herein preferably arrangeddistally of the proximal working channel opening and proximally of thefluid inlet.

Optionally, the handling device for receiving a shank tool can comprisesa first rotatable receiving part and a second receiving part which isconnected to the first receiving part in a rotationally fixed manner.The first receiving part can be fixedly coupled to a jacket element ofthe shank tool, for example via a Luer connection, nonetheless bedisplaceably mounted for the exact axial positioning relative to theworking channel inlet. The second receiving part can be coupled to adistal tool head, for example a capture basket or forceps jaw parts, viaa control wire which is led through the jacket element of the shanktool, and be axially displaceably mounted relative to the firstreceiving part. The shank tool can be pushed in the instrument throughthe first receiving part into different axial positions. By way of this,it is possible to insert the shank tool through the shank onto thedistal shank tip in a positioned manner, so that it firstly does notproject beyond it. The distal shank tip can consequently be moved to anoperating region in an uninhibited manner and a danger of injury due toa sharp-edged tool head is avoided. After reaching the operating region,by way of displacing the first receiving part in the distal direction,the shank tool can be pushed out of the distal shank end. The wire whichis coupled to the tool head, for example the capture basket or forcepsjaw parts, as the case may be can then be subsequently pushed out of thejacket element of the shank tool by way of displacing the secondreceiving part. The shank tool can be rotated by way of a rotationallyfixed coupling of the shank tool and of the first receiving part as wellas a rotationally fixed coupling between the second receiving part andthe first receiving part. By way of such a construction, furthermore itis very easily possible to position and actuate the shank tool by asingle user. Coordination with a second user is consequently notnecessary.

The first receiving part is optionally displaceable with respect to theworking channel inlet by a first displacement path. The second receivingpart is movable relative to the first receiving part by a seconddisplacement path. The length of the second displacement path can hereinoptionally exceed or fall short of the length of the first displacementpath. The first displacement path is exclusively conceived to bring theshank tool into a position which lies axially outside the distal shanktip. Herewith, the tool head can be extended out of the distal tipwithout hindrance. The length of the first displacement path can merelybe a few millimeters. It is conceivable to provide a displacement pathof roughly 5 mm. The first displacement part can also lie in a range of2 mm to 10 mm depending on the configuration of the endoscopic shank.The second displacement path in the meanwhile is dependent on the typeand size of the tool head and can be for example up to 20 or 25 mm.

The first receiving part and/or the second receiving part can optionallybe held in a momentary axial and/or rotated position via latching means.The first receiving part and/or the second receiving part for examplecould have a lateral surface which is provided with peripheral grooveswhich are arranged parallel to one another, wherein the grooves eachcomprise a rounded profile cross section. If these are led through asuitably dimensioned opening, the latching can be effected between twoconsecutive grooves. The latched position however can also be releasedagain by way of a suitable force transverse to the grooves.

The first receiving part and/or the second receiving part can further beconfigured with a shoulder which comprises a knurling. By way of this, auser can easily grip the respective receiving part and carry out arotation by feel and with a direct haptic feedback.

Optionally, a fluid channel which individually directly surrounds atleast two leads which run through the shank, to which the workingchannel also belongs, can be formed in the shank. Here “individuallydirectly surrounds” is to mean that the leads have no common sheathingwithin the fluid channel, but are peripherally rinsed by fluid in thefluid channel in a direct manner. The leads can each be sheathedindividually and for example be insulated. “Directly” here is thereforenot to be misunderstood to the extent that the leads may not have asheathing themselves. The leads can be of an optical nature, for exampleas fiber optics for coupling in and coupling out light at the distalend. In particular, the leads can comprise one or more laser fiberoptics, in order for example to shoot a kidney or urinary stone withlaser light and to thus vaporize it. Alternatively or additionally, oneor more of the leads can transmit electrical signals and/or electricalpower and be connected to a distal LED and/or to a distal picturesensor. Alternatively or additionally, the leads can transmit mechanicalcontrol signals for the jointless bending and/or controlling the distalshank end, for example as pull cables which are led laterally in theshank. All leads are each individually directly surrounded by the fluidchannel. “Surrounded” here is to mean that the leads at least to thelarger part are peripherally rinsed in cross section. They do not needto be completely peripherally rinsed in cross section by 360°, but canbear laterally on the shank or on one or more of the other leads.

On the one hand, concerning the endoscopic instrument which is disclosedhere, a fluid lead which is led through the shank can be done away with.Furthermore, the complete cross section of the inner volume of the shankwhich the leads do not occupy can be used as a fluid channel, so thatthe available cross section is better utilized. Herein, a shank outerdiameter of 3 mm or less can be realized.

Optionally, the fluid channel can serve as a feed channel and/ordischarge channel. Depending on the requirement, rinsing fluid forimproving the view at the distal shank end can be fed distally orrinsing fluid with an annoying tissue suspension can be led awayproximally. A return of fluid proximally can be effected by way ofactive suctioning or passively without active suctioning, for example byway of overpressure in the body of the patient.

Optionally, the fluid channel can comprise a distal fluid channelopening and a proximal fluid channel opening, wherein the proximal fluidchannel opening is arranged laterally on the shank and can be subjectedto fluid pressure or fluid vacuum. For this, a pressure pump or vacuumpump can be connected onto the proximal fluid channel opening or a fluidreservoir which is located at a height above the instrument can beconnected, as with a drip, so that a hydrostatic pressure bears in theproximal fluid channel opening. A saline solution can serve for exampleas a rinsing fluid.

Optionally, the instrument can comprise a seal device which forms aproximal end of the fluid channel and comprises feed-throughs for theleads. The seal device can comprise for example an elastomer cell foamblock which is arranged in a proximal end region of the shank and/or ina handling device which is connected or connectable to a proximal endregion of the shank. Preferably, the cell foam block is configured in aclosed-celled manner. The leads can be led through the seal devicethrough feed-throughs, wherein the feed-throughs each have an initiallysmaller diameter than the associated, led-through lead, however areelastically widened by the led-through lead. By way of this, a sealingeffect can be achieved, so that no fluid can flow proximally through thefeed-throughs axially out of the shank to the outside or into thehandling device. The fluid specifically is preferably not to flowaxially, but laterally through a proximal fluid channel opening which isprovided for this and which is arranged laterally on the shank andpreferably distally of the seal device.

Optionally, the instrument can comprise a handling device which isfixedly connected or releasably connectable to a proximal end of theshank. The handling device can preferably be configured ergonomically,such that it can be comfortably gripped by a treating person and lieswell in the hand, in order to manually control the instrument. For this,the handing device can be configured in an essentially Y-shaped mannerwith two rigid grip limbs which distally run together towards the shank.The handling device can then either be gripped such that both grip limbscan be gripped around as a forceps or the ball of the thumb is ledbetween the grip limbs. Concerning the first posture, the index fingercan be applied on a gun-like trigger for pulling a pull cable below theshank. Concerning the second posture, the index finger can be applied onan upper trigger for pulling an upper pull cable above the shank and themiddle finger applied on a lower trigger for pulling a lower pull cablebelow the shank. The upper pull cable and the lower pull cable can beconfigured as sections of a pull cable which is deflected around a guideroller which in the handling device is rotatably mounted about an axiswhich is transverse to the longitudinal axis of the shank. Depending onthe rotation direction of the guide roller, the upper or the lower pullcable is pulled proximally whilst the respective other pull cable yieldsdistally. The upper trigger and the lower trigger can each be directlyconnected to one another via a guide roller or be coupled in an indirectmanner, so that they move oppositely on actuation. It is particular, thesecond posture which ergonomically particularly advantageous, since thelongitudinal axis of the shank runs essentially coaxially to thelongitudinal axis of the lower arm, so that the instrument can becomfortably rotated by supination and pronation of the lower arm aboutits longitudinal axis. Furthermore, by way of actuating the upper orlower trigger with the index finger or middle finger, an abrupt bendingof the distal shank end can be effected in two opposite directions byway of the upper and lower pull cable. Concerning the first posture, thehandling device can be peripherally gripped by 180°, in order to pullthe other trigger with the index finger, or the instrument can berotated by 180° about its longitudinal axis, in order to effect anabrupt bending of the distal shank end by way of the upper or lower pullcable in two opposite directions. The leads can be led through one orboth of the grip limbs of the handling device and at a proximal end ofthe grip limb or grip limbs can each comprise a proximal-sideconnection. The working channel is preferably led through a grip limb ofthe handling device and other leads through the other grip limb of thehandling device.

Optionally, the shank at least in a part-section can be flexible orsemi-flexible. In particular, a high torsional stiffness given a certainbending flexibility is advantageous for the exact control of the distalshank end. The bending stiffness can be quantitatively dimensioned byway of how deep the distal shank end sags downwards solely under theweight force of the shank given a horizontal position of the instrument.It has been found that it is particularly advantageous if the distalshank end sags downwards solely by the weight force of the shank by 20%to 60% of the shank length given a horizontal position of theinstrument. In this range of the bending stiffness, the shank isflexible enough, in order to be able to penetrate as deeply andsimultaneously minimally invasively as possible into the kidney tube andureter and is flexurally rigid enough, in order to be able to controlthe distal shank end in a controlled manner.

Optionally, the instrument or at least the shank can be configured as adisposable article for disposal after having been used once. This is aparticularly advantageous embodiment since the cleaning of theinstrument for further uses is done away with and the components andmaterials only need to be configured for a single use. The leads whichare individually directly surrounded by the fluid channel can beconfigured in a very delicate manner and without consideration of theconfiguration of poorly cleanable corners, edges and/or dead spaces bythe fluid channel. On account of the delicate configuration of the leadsand the shank itself, a shank outer diameter of 2.7 mm or less can berealized.

Optionally, the cross-sectional area of the fluid channel can correspondto the cross-sectional area of a shank interior which is formed by theshank, minus the sum of the cross-sectional area of all leads which runthrough the shank interior. This means that no unused cross-sectionalarea results in the shank and the shank interior can therefore beoptimally utilized.

Optionally, the shank can comprise a plurality of slots in a distalregion. Herein, the slots can only extend over a part of the shankperiphery in the circumferential direction. Herein, the flexibility ofthe shank can be locally increased, thus the bending radius can belocally reduced, in order to achieve a bending of the distal shank endby up to 140. Alternatively or additionally, the slots can be arrangedaxially to one another in a manner such that they lie alternately on afirst lateral side of the shank and on a second lateral side of theshank which lies diametrically opposite the first. Herewith, the distalshank end can be bent in two opposite directions and given pull cableswhich are accordingly actuatable independently of one another can evenexecute two opposite curved bends in an S-shaped manner. For the curvedbending to a first side, the slots are pressed together at a first asideand the slots are pulled apart at a second side which is opposite to thefirst side. Accordingly, for the curvature to the second side, the slotsare pressed together at the second side and the slots are pulled apartat the first side. The pull cables then preferably run in the shankalong the first and second side and engage on the distal shank end, inorder to bend away the distal shank end to the respective side by way ofa pulling force.

Optionally, the slots on the one hand can serve as a distal fluidchannel opening for the fluid channel and on the other hand for locallyincreasing the flexibility of the shank for the bending away of a distalshank end. The rinsing fluid can then exit laterally out of the shankproximally of the distal shank end. Amongst other things, this has theadvantage that more cross section for functions such as for instance apicture sensor and/or at least one illumination LED is available at thedistal shank end.

Optionally, the working channel can be a first working channel, whereinthe instrument comprises a second working channel which runs through theshank and which is likewise directly surrounded by the fluid channel.Such a second working channel can be selectively used in differentmanners. Inasmuch as the instrument does not already comprises anoptical lead such as a laser fiber optic which is led through the fluidchannel, such a laser fiber optic can be introduced through the secondworking channel from an associated proximal working channel opening, forexample at a proximal axial end of a grip limb of the handling device,and be pushed through the second working channel up to a distal workingchannel opening at the distal shank end. Laser light can be coupled inby the laser fiber optic, in order for example to vaporize a kidneystone or urinary stone and to flush it out of the rinsing channel by wayof rinsing fluid. The laser fiber optic when not in use can be withdrawnfrom the working channel again, in order to release this for possibleother uses. A capture basket insert or a Dormia loop insert can bepushed through the first working channel in parallel, in order herewithto capture a kidney stone or urinary stone at the distal shank end. Theproximal working channel opening of the first working channel, forexample at a proximal axial end of a grip limb of the handling devicecan comprise a Luer lock connection, in order to fix a jacket element ofthe capture basket insert or of a Dormia loop insert with respect to theinstrument, and by way of pushing a wire which leads through the jacketand which at the distal side forms the capture basket or the Dormialoop, to open the capture basket or the Dormia loop. The capture basketor the Dormia loop closes on pulling the wire when the jacket isarrested in the Luer lock connection.

Optionally, a working channel can serve as a feed channel and/ordischarge channel with a flow direction which is opposite with respectto the fluid channel. In particular, this is advantageous if, given alonger treatment time and larger quantities of rinsing fluid, this mustbe led away out of the body again without interrupting the treatment. Areturn of rinsing fluid at the outer side of the shank or through anadditionally inserted auxiliary shank leads to an additionally expansionof the tissue and is disadvantageous with respect to a minimal invasiveoperation. Furthermore, an overpressure can build up, such counteractingthe flow of rinsing agent. The working channel can preferably be used asa feed conduit of rinsing fluid which is led away via the fluid channelas a discharge conduit. Alternatively, the flow of rinsing agent can runthe other way round, so that the working channel serves as a dischargechannel and the fluid channel as a feed channel. The use of the workingchannel as a feed channel and/or as a discharge channel can simplify acontinuous rinsing.

Optionally, the first and/or the second working channel can run axiallythrough a sealed proximal end of the fluid channel. The working channeltherefore, analogously to the other leads, can be led through anassociated axial feed-through in the seal device which is configured forexample in the form of an elastomer cell foam block.

Optionally, the respective proximal working channel opening can bearranged proximally of the proximal end of the fluid channel, preferablyat a proximal axial end of a grip limb of the handling device. Herewith,the respective working channel can be used in a comprehensive aspossible manner and is as straight as possible which is to say has onlyrelatively large bending radii.

Optionally, the respective distal working channel opening can bearranged distally of a distal fluid channel opening of the fluidchannel. Herewith, in particular a kidney stone or urinary stone whichis smashed can be led away through the respective working channel,wherein clear viewing conditions are created by way of the lateraldischarge or run-off of rinsing fluid through the fluid channel opening.

Optionally, the cross section of the respective distal working channelopening can be smaller than the cross section of the respective workingchannel. Herewith, the risk of blockage of the respective workingchannel is reduced, since the smaller working channel opening acts as afilter to large pieces of tissue and these cannot pass through theworking channel opening.

Optionally, the cross section of the respective distal working channelcan taper towards the distal working channel opening. Herewith, aninner-side step or edge in front of the smaller working channel openingis avoided, on which a laser fiber optic which is inserted through therespective working channel, or an inserted shank tool, such as a capturebasket insert and/or a Dormia loop insert could snag.

Optionally, a throughflow direction and/or throughflow rate through thefluid channel can be selected or set. This can be carried out forexample via a pressure control and/or by way of opening and closing avalve, preferably on the proximal fluid channel opening.

Optionally, a distal shank end can be jointlessly bendable in acontrollable manner. This can be preferably realized as described abovevia a bending flexibility of the shank which is locally increased by wayof lateral slots in the shank, and via at least one pull cable whichlaterally engages on the distal shank end.

On use of a fiber optic and in particular a laser fiber optic with anouter diameter of significantly below 1 mm, for example 272 μm, adedicated second working channel with a cross section (e.g. 1.65Fr.=0.55 mm) which is significantly less than the first cross section ofthe first working channel (e.g. 3.6 Fr.=1.2 mm) which is used forleading through the capture basket can be provided. Herewith, a laserfiber optic for destroying a kidney stone or urinary stone and a capturebasket for capturing fragments of the kidney stone or urinary stone canbe simultaneously arranged in the shank and be operated in parallel.Preferably, the inner diameter of the second working channel exceeds theouter diameter of the fiber optic by 30% at the most, at least in abendable shank region. By way of this, one allows a fiber optic to beable to be displaced in the second channel even in the case of a bentdistal tip of the endoscopic instrument. A relatively sharp-edged end ofthe fiber optic, on account of the specified diameter ratio, undergoesonly a relatively small engagement angle to its surface and does notinjure it, even in the case of an arcuate course of the working channel.The second working channel and the endoscopic instrument areconsequently not un-tight and can be used or a further duration. Arinsing performance is further improved by way of replacing aconventional working channel by a significantly narrower workingchannel. The outer diameter of the fiber optic can lie in a region of0.4 mm to 0.7 mm, preferably in a region of 0.45 mm to 0.6 mm andparticularly preferably of 0.45 to 0.5 mm. It particularly lends itselfto equip an endoscopic instrument with such a second working channel,concerning which a fluid channel which individually directly surroundstwo leads which run through the shank is formed in the shank.

Optionally, the material of the first and/or second separate workingchannel for the fiber optic can be polyimide or polyamide. The firstand/or second working channel should consist of a hard as possiblematerial and herein it should change its cross section as little aspossible in the bent state. By way of this, the danger of the shank toolor fiber optic penetrating into the inner surface of the working channelis significantly reduced. The material for the respective workingchannel can be for instance polyimide or polyamide (also known as nylon)in a corresponding hardness.

Optionally, the wall of the first and/or second separate working channelcan comprise reinforcements. In particular, these can run incircumferential direction and prevent a bending collapse of the crosssection of the separate working channel.

Further optionally, the material of the first and/or second separateworking channel can also comprise a metallic material. This can comprisefor instance nitinol which is a nickel-titanium alloy with super elasticcharacteristics at room temperature. This material can have the demandedand necessary elasticity/flexibility/bending possibility given theaforementioned small diameters.

According to a further aspect of the present disclosure, on use of anendoscopic instrument with a shank with a jointlessly bendable distaltip, an arrangement of first slots which are optionally locatedalternately on a first lateral side of the shank and on a second lateralside of the shank which is diametrically opposite to the first can beprovided. By way of this one can achieve a jointless bending in a mainbending plane without having to create individual segments which areconnected by a joint and which partly extend into the inner lumen of theshank. For further improving the movability, optionally several secondslots which are offset to the first slots by 90° can connect proximallyonto the region with first slots. The second slots can extend in thecircumferential direction preferably only over a part of the shankperiphery. Further preferably, the two slots are arranged axially to oneanother in a manner such that they alternately lie on a third lateralside of the shank and a fourth lateral side of the shank which liesdiametrically opposite the third. By way of this, a second bending planewhich lies transversely to the main bending plane is formed.

The movability in the second bending plane can be adjusted depending onthe number of second slots. It particularly lends itself to select thenumber of the second slots in a manner such that the distal end of theshank is bendable in the second bending plane about an angular range ofat least +/−15 and preferably of +/−20. It is particularly the abilityto reach kidney stones in the lower caliceal region of the kidneys whichcan be improved by way of this.

The movement of the distal end of the shank in the second bending planecan be achieved by way of separate mechanical leads in particular pullwires. These are coupled to the shank in a direct manner distally infront of the region which is provided with second slots. Anaforementioned handling device can be applied for moving the pull wires.

According to a further aspect of the present disclosure, on use of anendoscopic instrument which comprises a shank which can be coupled to ahandling device and is with a jointlessly bendable distal tip and inwhich a fluid channel is formed, said fluid channel individuallydirectly surrounding at least two leads which run through the shank, aseal device or a sealing means can be provided, in order to seal theleads with respect to the handling device. As a result, the sealingmeans forms a proximal end of the fluid channel. The sealing means ispreferably coupled to the shank in a rotationally fixed manner. Therotating of the shank consequently leads to a rotating of the leads andsealing means, so that the relative positions of the leads which are ledthrough the sealing means, to the sealing means, remain unchanged. Thesealing means is therefore not loaded by transverse forces which couldelastically deform the material of the sealing means to such an extentthat a sealing effect is at least regionally lifted. The rotationallyfixed coupling can be realized by way of positive fit means which areformed in the sealing means and in the seal receiver in a mannercorresponding to one another.

Optionally, the sealing means has a disc-like, round shape. Herein, thesealing means can be easily pressed into the seal receiver.

Optionally, the positive-fit means can be realized in the form of aperipheral tongue and groove arrangement. The groove can project into aperipheral surface of the sealing means or be formed in the sealreceiver. The tongue could be formed in the seal receiver or in thesealing means as a radial projection. The positive fit means arepreferably arranged exclusively at a single, peripheral-side position,so that a correct placement of the sealing means is achieved even in thecase of a sealing means which is configured in a non-symmetrical manner.

Optionally, the sealing means can comprise at least two slots asfeed-throughs which pass through a peripheral surface of the sealingmeans and each extend partly through the sealing means. The slots can beprovided for leading mechanical leads such as for instance pull wires,through the sealing means. The pull wires extend from the handlingdevice to the distal end of the shank and can be used to bend the distaltip. If the pull wires are configured as flat wires, then these can alsobe sealingly led through the sealing means in a reliable manner.

Optionally, the sealing means can comprise four slots as feed-throughs,said slots being arranged in the sealing means in a manner distanced toone another. As a result, the sealing means can also be applied forsealing a fluid channel in a shank of an endoscopic instrument,concerning which the tip is jointlessly bendable in a main bending planeand additionally movable in a second bending plane. Consequently, theendoscopic instrument can comprise four mechanical leads in the form ofpull wires or the like, which are led through the four slots and extendthrough the shank. The size and alignment of the slots is hereindependent on the type and arrangement of the pull wires.

Further optionally, the slots can also be based on radial lines whichare displaced in parallel and which are offset to one another by atleast 90° on a surface which is covered by the sealing means. The slotscan project beyond a middle line which runs perpendicularly to therespective slot and which intersects a middle point of the sealingmeans. If four pull wires are applied, then four slots are necessary andthese are then offset to one another for example by 90°. Given only twopull wires, two slots can be sufficient and these are then offset to oneanother for example by 180°.

Optionally, the sealing means can be manufactured of a material whichcomprises polyethylene or cellular rubber. Cellular rubber can be basedfor example on a fluoropolymer.

Optionally, the endoscopic instrument which comprises the sealing meansexplained above can comprise a shank connection part which is rotatablein a control housing and which is fixedly connectable to the shank. Theshank connection part can optionally comprise a connection pipe stubwhich extends radially outwards from a shank connection axis.Optionally, a sealing ring can be arranged between a seal receiver forreceiving the sealing means and the shank connection part.

Further optionally, the shank connection part comprises guide devicesfor guiding pull wires. By way of guiding the pull wires, these candirectly follow each rotation of the shank connection part. A crossingof the pull wires and of the associated slots in the sealing means canbe prevented, so that the sealing effect is not compromised by way ofthis. The seal receiver can further be supplemented by a cover in thedistal direction, said cover being away from the shank connection partand likewise being coupled to the shank connection part in arotationally fixed manner. The cover can further likewise comprise guidedevices, with which pull wires can be led. The guide devices in thecover and in the shank connection part are preferably flush, so that thesealing means experiences exclusively axial forces of the pull wires.

According to a further aspect of the present disclosure, concerning anendoscopic instrument which comprises a shank which can be coupled to ahandling device, a shank tool, for example with a capture basket whichis integrated therein or a forceps, can be pushed through a workingchannel of the instrument onto the distal end of the instrument. Thehandling device for this can preferably comprise a working channelinlet, a first rotatable receiving part and a second receiving partwhich is connected to the first receiving part in a rotationally fixedmanner. The first receiving part can be fixedly coupled to a jacketelement of the shank tool, for example via a Luer connection,nonetheless be displaceably mounted for the exact axial positioningrelative to the working channel inlet. The second receiving part can becoupled to a distal tool head, for example a capture basket or forcepsjaw parts, via a control wire which is led through the jacket element ofthe shank tool, and be axially displaceably mounted relative to thefirst receiving part. The shank tool can be pushed in the instrumentinto different axial positions through the first receiving part. By wayof this, it is possible to insert the shank tool through the shank ontothe distal shank tip in a positioned manner, so that it firstly does notproject beyond it. The distal shank tip can consequently be moved to anoperation region in an uninhibited manner and a danger of injury due toa sharp-edged tool head is avoided. After reaching the operationalregion, by way of displacing the first receiving part in the distaldirection, the shank tool can be pushed out of the distal shank end. Thewire which is coupled to the tool head, for example the capture basketor forceps jaw parts, as the case may be can then be subsequently pushedout of the jacket element of the shank tool by way of displacing thesecond receiving part. The shank tool can be rotated by way of arotationally fixed coupling of the shank tool and of the first receivingpart as well as a rotationally fixed coupling between the secondreceiving part and the first receiving part. By way of such aconstruction, furthermore it is very easily possible to position andactuate the shank tool by a single user. Coordination with a second useris consequently not necessary.

The first receiving part and/or the second receiving part can optionallybe held in a momentary axial and/or rotated position via latching means.The first receiving part and/or the second receiving part for examplecould have a lateral surface which is provided with peripheral grooveswhich are arranged parallel to one another, wherein the grooves eachcomprise a rounded profile cross section. If these are led through asuitably dimensioned opening, the latching can be effected between twoconsecutive grooves. The latched position however can also be releasedagain by way of a suitable force transverse to the grooves.

The at least one cam disc is optionally fixable in its momentaryposition via an arresting device. The arresting device could be realizedfor example in the form of a knurled screw, with which a user can arresta position of the at least one cam disc, said position having been setonce. A jointless bending which is created by the pull wires canconsequently remain in its state, without it having to be retained byway of permanent manual intervention which is demanding.

The previously described aspects of the present disclosure althoughbeing preferably applied in an arbitrary combination in the embodimentsof an endoscopic instrument which is disclosed here, however they canalso be advantageously applied independently of one another without theother aspects.

The invention is hereinafter explained in more detail by way ofembodiment examples which are represented in the drawing. The variousfeatures of novelty which characterize the invention are pointed outwith particularity in the claims annexed to and forming a part of thisdisclosure. For a better understanding of the invention, its operatingadvantages and specific objects attained by its uses, reference is madeto the accompanying drawings and descriptive matter in which preferredembodiments of the invention are illustrated.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 is a perspective view of an example of an embodiment of anendoscopic instrument which is disclosed herein;

FIG. 2a, 2b are perspective views of a distal end section of anexemplary embodiment of an endoscopic instrument which is disclosedherein;

FIG. 3a, 3b, 3c are exploded perspective views of parts of an exemplaryembodiment of a working channel of an endoscopic instrument which isdisclosed herein;

FIG. 4a, 4b are schematic cross-sectional views of a distal end sectionof a working channel of an exemplary embodiment of an endoscopicinstrument which is disclosed herein;

FIG. 5 is a cross-sectional view of a proximal connection section of anexemplary embodiment of an endoscopic instrument which is disclosedherein;

FIG. 6a, 6b, 6c are lateral views of a handling device with detailedviews of the distal shank end of an exemplary embodiment of aninstrument which is disclosed herein;

FIG. 7a, 7b, 7c, 7d, 7e, 7f are different views on the shank and inparticular the distal shank end of an exemplary embodiment of anendoscopic instrument which is disclosed herein;

FIG. 8a, 8b, 8c, 8d, 8e are further views on the shank and in particulara bendable shank section of an exemplary embodiment of an endoscopicinstrument which is disclosed herein;

FIG. 9a, 9b, 9c, 9d are different views on an embodiment example of anendoscopic instrument which is disclosed herein; and

FIG. 10a, 10b, 10c are further views of the embodiment example accordingto FIG. 9a -d.

DESCRIPTION OF PREFERRED EMBODIMENTS

Referring to the drawings, FIG. 1 by way of example shows an endoscopicinstrument 1 which comprises a tubular shank 3 for insertion into a bodycavity. The shank 3 is connected to a handling device 5 at a proximalend 4 and in its inner lumen forms a fluid channel 7. The shank 3furthermore at a distal, bendable shank section 9 is configured in atleast partly flexible manner, in order when necessary to be bent by wayof the action of the handling device 5.

It is evident in a part-section A-A through the shank 7 that by way ofexample a first optical and/or electrical lead 11 for the illuminationat the distal shank end 17, a second optical and/or electrical lead 13for taking pictures at the distal shank end 17, a first working channel15 and a second working channel 19 run in the fluid channel 7. An LED asa light source can be arranged at the distal end of the first lead 11,wherein the lead 11 serves as an electrical electricity supply lead tothe LED. Alternatively or additionally, a fiber optic outcoupling as alight source can be arranged at the distal end of the first lead 11,wherein the lead 11 serves as an optical fiber optic. Analogously tothis, an objective with a picture senor for taking pictures can bearranged at the distal end of the second lead 13, wherein the lead 11serves as an electrical electricity supply lead of the picture sensorand for signal transmission. Alternatively or additionally, a fiberoptic incoupling can be arranged at the distal end of the second lead13, wherein the lead 13 serves as an optical fiber optic.

The first working channel 15 preferably has at least double the crosssection of the second working channel 19. The first working channel 15can selectively serve as an insert channel for a shank tool, for examplea capture basket, a scissors or a forceps. Alternatively oradditionally, even given an inserted shank tool, the first workingchannel 15 can serve as a feed or discharge conduit of rinsing fluid.The second working channel 19 can preferably serve as an insert channelfor a laser fiber optic, in order to be able to destroy kidney stones orurinary stones with laser light. The inner diameter of the second,smaller working channel 19, at least in the bendable shank section 9should exceed the outer diameter of the laser fiber optic by 30% at themost, in order to ensure a secure leading-through of the laser fibberoptic.

All leads 11, 13, 15 and 19 are individually surrounded by the fluidchannel 7 in a direct manner. The particularity of this arrangement liesin the fact that the four exemplary leads 11, 13, 15 and 19 areindividually arranged in the fluid channel 7 and, if fluid flows there,are consequent peripherally rinsed by the fluid in a direct manner. Thecomplete remaining cross-sectional area of the fluid channel 7 canconsequently be used for a fluid. The cross-sectional area of the fluidchannel 7 consequently corresponds to the cross-sectional area of ashank interior which is formed by the shank 3 minus the sum ofcross-sectional areas of all leads 11, 13, 5, and 19 which run throughthe shank interior as well as of all further leads which are to beconsidered. A separate fluid channel which always demands an independentsheathing within the shank 3 is not necessary, since the first workingchannel 15 can itself be used as a feed or discharge conduit for rinsingfluid even in the case of an inserted shank tool. The shank 3 canconsequently be provided with a particularly small outer diameter. Withthis construction, the possible problem of a more difficult cleaningability or sterilization ability can be solved by way of the completeendoscopic instrument 1 preferably being configured as a disposablearticle for disposal after single use, thus does not need to besterilized at all after use.

Of course, other, less or more leads which can run in the fluid channel7 in this manner are also conceivable. For instance, leads fortransmitting electrical signals and/or electrical power are conceivable.Furthermore, distally arranged light diodes can be provided withelectrical power via these, or picture signals can be transmitted from adistally arranged picture sensor. The leads 11, 13, 15 and 19 as well asall alternative or additional leads can each comprise an individualencasing. This can be important particularly in the case of electricalleads, in order to insulate these. Additionally, mechanical leads in theform of control cables can be led in the shank, in order to jointlesslybend the bendable shank section 9 or to control it in is shape inanother manner. The mechanical leads for instance can be pull cables orpull wires which are led on lateral inner surfaces in the shank 3.

The distal bendable shank section 9 as a distal region is provided withseveral slots 33 which give the bendable shank section 9 its movability.The distal bendable shank section 9 is consequently flexible or at leastpartly flexible, thus semi-flexible. Instead of the use of individuallinks which are connected to one another in an articulated manner, theshank section 9 can be rendered flexible about at least one axis ofcurvature by way of a targeted slotting. For this, the slots arepreferably incorporated into the shank in the circumferential direction,extend over the complete material thickness of the shank jacket and runover more than half the circumference, for example up to 270°. Twolamella-like parts of the shank 3 which are consecutive along theextension direction of the shank 3 and between which a slot 33 islocated in a peripheral surface 35 of the shank 3 are consequentlyconnected to one another by a web which in this case extends in thecircumferential direction by way of example by at least 90°. On accountof the single-piece configuration, the webs which remain between theindividual lamella-like parts always have the tendency to assume aninitial, unloaded position, in which the shank 3 preferably runs in astraight line. If the preferably metallic shank 3 is consequently bentby way of a pull cable due to the action of a tensile force, the distalbendable shank section 9 can be jointlessly bent by up to 300°. Afterthe release of the pulling force, by way of the webs which spring back,the shank 3 strives to return back into its straight shape. In order toachieve a uniform flexibility, the slots 33 are arranged axially to oneanother in a manner such that they lie alternately on a first lateralside of the shank 3 and on a second lateral side of the shank 3 which isdiametrical opposite to the first side.

The slots 33 can be incorporated into the shank by way of a machiningdevice which preferably uses a laser. By way of this, a rapid,inexpensive machining can be effected, and such is no obstacle to aconfiguration of the instrument 1 as a disposable article. Very delicatestructures can be created by way of a suitable leading of the beam ofthe laser. The clear width of the slots 33 can be dimensioned so small,that tissue does not penetrate into the slots 33 and an unhindereddisplacement of the shank 3 into the operation region can be effected.The slots 33 can be rounded in their profile. Optionally, a coating ofthe shank 3 can be effected with a lubricative coating. The slotted,bendable shank section 9 is preferably surrounded by a protective tube199 (see FIG. 7f ). The protective tube can for example befabric-reinforced and/or shrunk on. The protective tube can comprise forexample bio-compatible plastic.

The fluid channel 7 in the inner lumen of the shank 3 can serve as afeed channel and/or discharge channel for a rinsing fluid which isdelivered through the free residual cross section. It is conceivable forrinsing fluid to be fed distally out of the slots which then act asdistal fluid channel openings or for rinsing fluid with an annoyingtissue suspension to be led away proximally, in accordance withrequirements for improving the view at the distal end 17. Given thesubsequent use of the fluid channel 7 without the first working channel15 as a feed channel and/or discharge channel, it is conceivable totemporarily either only feed rinsing fluid or only discharge it. Thefeeding of the rinsing fluid can be effected for example actively by wayof an external pump or passively by way of the hydraulic pressure from adrip which is connected and suspended at a higher level. The dischargingcan be effected by way of an overpressure in the operation region beinggenerated by the rinsing, by way of which overpressure rinsing fluid cansubsequently exit proximally at the outer side along the shank 3. Thefirst working channel 15 however preferably serves as a feed channel andthe fluid channel 7 as a discharge channel, or vice versa. By way ofthis, an undesired fluid flow at the outside on the shank 3 can belargely reduced or completely avoided.

Hence for the continuous rinsing, it can make sense to use the firstworking channel 15 which extends distally through the fluid channel 7and which comprises a first distal working channel opening 18 as a feedand/or discharge channel. The cross section of the first distal workingchannel opening 18 can be smaller than the cross section of the firstworking channel 15, so that the blocking of the first working channel 15by tissue which enters via the distal working channel opening 18 isprevented. Alternatively or additionally to this, the cross section ofthe first working channel 15 can taper towards the distal workingchannel opening 18. The first working channel 19 can be continuouslysupplied with rinsing fluid by way of an external pump or one which isarranged in the handing device 5 or from a connected drip which issuspended at a higher level, said rinsing fluid being led distally andexiting directly at the distal shank end 17. The first working channel15 is consequently a feed channel. On account of the overpressure whichsets in, the rinsing fluid gets through the slots 33 and/or lateralrinsing openings 203 (see FIG. 7b,c ) into the fluid channel 7 and flowsproximally back from there. This is indicated in FIG. 1 by the flowlines 21 which lead from a purely axial, distally directed outflow fromthe distal shank end 17 to a lateral inflow through the slots 33 and/orlateral rinsing openings. The flow direction in the first workingchannel 15 is consequently in opposite directions to that of the fluidchannel 7. Of course, this could also be effected in a reverseconstellation by way of rinsing fluid exiting out of the slots 33 and/orthe lateral rinsing openings in the distal bendable shank section 9 andbeing led back at the distal shank end 17 via the first working channel15. If the slots 33 are surrounded by a protective tube 199 and/or alubricative coating, then the leading of the fluid can be effectedexclusively via lateral rinsing openings 203.

The handling device 5 is merely represent by way of example in FIG. 1.Further handling devices are shown in the FIGS. 6a-c ﬀ. All variants ofhandling devices can be combined with the advantageous configurations ofthe shank 3 which are outlined here. Furthermore, other handling deviceswhich in their shape differ from the variants which are shown here arealso conceivable.

Concerning the handling device 5 in FIG. 1, a housing 23 is shown, saidhousing by way of example having a grip opening 25 for leading through athumb and being configured such that the ball of the thumb of a handthen lies on a contact surface 27 which is directed to the shank 3. Twooperating levers or triggers 29, 31 which are arranged on lateral sidesof the housing 23 which are opposite one another connect directly ingrip reach of the other finger of the hand. If the ball of the thumb islocated on the contact surface 27 then for instance the lower trigger 29can be operated by a middle finger whilst the index finger lies on theupper trigger 21. By way of pulling the triggers 29 and 31 to the gripopening 25, the pull cables 11 and 13 which are coupled thereto arepulled. In order to avoid stresses within the shank 3 and to carry out aharmonic movement of the distal bendable shank section 9, the two pullcables could each be configured as a section of an individual pull cablewhich runs between the two triggers 29, 31 via a guide roller. Iftherefore for instance the lower trigger 29 is moved, then for examplethe first pull cable 11 is pulled, wherein the upper trigger 31 is movedin the opposite direction and herein relaxes the second pull cable 13.For this, both triggers 29, 31 could be connected to one another via theguide roller which is not shown here or be coupled to one another in anindirect manner so that they automatically move in opposite directionson actuation.

The first, larger working channel 15 can run on a side 37 of thehandling device 5 which faces the upper trigger 31, so that a firstproximal working channel opening 39 for the selective introduction of arinsing fluid, for example NaCl solution or of a shank tool is presentthere. Other leads, for example the second, smaller working channel 19for a laser fiber optic can run out into a respective second proximalworking channel opening 43 a or 43 b at a side 41 which faces the lowertrigger 20. The fluid channel 7 comprises a proximal fluid channelopening 45 in the form of a pipe stub which runs transversely to theshank 3 and out of which the rinsing fluid which flows back then finallyexits.

A shank 47 of an endoscopic instrument is shown in a part view in FIGS.2a and 2b . The view is concentrated onto a flexible distal bendableshank section 49 with a distal end 51 of the shank 3, on which a firstdistal working channel opening 52 is arranged. The cross section of thisfirst distal working channel opening 52 can be smaller than that of thefirst working channel 15 which is not shown here. Alternatively oradditionally to this, the cross section of the first working channel 15can taper to the first distal working channel opening 52. The shank 47proximally comprises a rigid, tubular section which is not visible hereand which is connectable to a handling device 5. This can correspond tothe handling device 5 of FIG. 1 or be configured as a handling devicewhich is represented in FIG. 6a -c.

A fluid channel 53 which is formed in the shank 47 can be recognizedwith a distal viewing direction. The distal, bendable shank section 49is configured such that it can be bent in the simplest manner withoutnecessitating dedicated joints which project into the fluid channel 53or lead to an enlarged outer diameter of the shank 47. For this, thedistal, bendable shank section 49 as a distal region is provided withseveral first slots 55 which run parallel to one another, are distancedto one another and locally completely penetrate the material of theshank 47. The first slots 55 by way of example extend over an angle of270° in the circumferential direction and herein run around a mainextension direction of the shank 47 which runs from a proximal end tothe distal end 51. By way of example, slots 55 which are adjacent whichis to say are consecutive are offset to one another in thecircumferential direction by 180°. The first slots 55 are accordinglyarranged axially to one another in a manner such that they alternatelylie on a first lateral side of the shank 47 and on a second lateral sideof the shank 47 which lies diametrically opposite the first side. As aresult, the distal bendable shank section 49 has a very flexible shape.Individual lamella-like parts of the shank 47 which are separated fromone another by way of slots 55 can change in their alignment to oneanother by way of widening or compressing the slots 55. By way of this,the bendable shank section 49 undergoes a jointless bending of up to300°. This movement of the bendable shanks section 49 can be influencedby mechanical pulls wires 57 and 59 which run in the fluid channel 53.Herewith, a pulling and relaxing of lateral sections of the bendableshank section 40 can be effected in a targeted manner.

The complete shank 47 can be configured in a single-part manner by wayof this advantageous configuration, which has a positive effect on theachievable minimal outer diameter of the shank 47. As in therepresentation of FIG. 1, here too there are two lamella-like partswhich are consecutive along the direction of extension of the shank 47and between which a slot 55 is located, and are consequently connectedto one another by a web which in this case extends over 270° in thecircumferential direction. On account of the single-piece configuration,the webs which remains between the individual parts tend to assume aninitial unloaded position, in which the shank 47 preferably runs in astraight line. If the shank 49 is subsequently bent by way of the actionof a tensile force by one of the mechanical leads 57 or 59, the shank 47after releasing the tensile force has a tendency to return into itsstraight shape by way of the webs which spring back. The bendable shanksection 49 therefore acts like a spring. A protective tube whichsurrounds the bendable sank section 49 can assist this spring effectwhich forces it into the initial straight shape.

On account of this arrangement of the first slots 55, a bending can becarried out on a single plane which is spanned by the peripheral sidemiddle points of the slots 55. Concerning the special application in thefield of the destruction of kidney stones, the distal bendable shanksection 49 is jointlessly bendable by up to 300° on account of therequired ability of the stones in the lower caliceal group of thekidneys to be reached.

It is advantageous to be able to also laterally bend the bendable shanksection 49 in two opposite directions for example by up to 20 or 25, inorder to enlarge the spatial region, in which in particular one canmachine the respective stone or another object with a laser. This isachieved by way of subdividing the distal bendable shank section 49 intoa first region 61 and into a second region 63, in which differentlyaligned slots 55 are arranged. In the first region 61 which extends upto the distal end 51, the first slots 55 are each offset to one anotherby 180°. By way of this, as described above, one realizes a main bendingplane. Two slots 64 which in the circumferential direction are offset tothe first slots by 90° in the first region are provided in the secondregion 63 which extends proximally from the first region 61. The secondregion 63 extends over a significantly shorter stretch that the firstregion 61, wherein the distances of the slots 55 and 64 in both regions61 and 63 are preferably identical. The second slots 64 are arrangedaxially to one another in a manner such that they lie alternately onsides of the shank 47 which are diametrically opposite one another. As aresult, on account of the second region 63 which is configured in such amanner, a limited movability in a plane which runs perpendicularly tothe main bending plane is possible. The movability can be limited by wayof the number of the second slots 64, for example to an angle range ofabout +/−20. A movement can be realized by two further mechanical leads65 and 67 which are coupled to the shank 47 distally in front of thesecond region 63 in a direct manner and can likewise be configured aspull wires. It is by way of the combination of these two bends that itis rendered possible for a laser fiber to exactly scan a recognizedobject in a relatively large working region.

In FIG. 2a , a slight offset to the left in the plane of the drawing isachieved, as is indicated by the angle ß. Here, consequently the firstregion 61 and herewith the main bending plane is pivoted to a side byabout 20. In FIG. 2b , a pivoting in the other direction is shown, as isindicated by the angle ß. The distal end 51 of the shank 47 can be movedin a significantly improved manner due to the second region 63 with theslots 55 which are arranged therein as well as due to the additionalmechanical leads 65 and 67. On account of the single-piececonfiguration, one can simultaneously further succeed in the shank 47having an adequate strength, in order to move the distal end 51 in adirect manner by way of rotating the shank 47.

FIGS. 3a to 3c show a detail of an endoscopic device which comprises afluid channel which as in the preceding figures can be configured as afluid channel 7 or fluid channel 53. However, only a small part of thedevice is represented in the figures, so that a shank and a fluidchannel are not visible. A part of a control housing 69 is shown, intowhich control housing a shank connection part 71, with which a shank canbe coupled is integrated. This shank is not represented here and can beconfigured according to the principles of FIGS. 1, 2 a, and 2 b.However, it can also lend itself to couple a conventional shank to theshank connection part 71, as long as it comprises an aforementionedfluid channel.

A proximal fluid channel opening in the form of a connection pipe stub73 is arranged on the shank connection part 71, said stub extendingoutwards transversely to a shank connection axis 75 on an outerperiphery. Rinsing fluid which comes from the fluid channel 7, 53 canexit via the connection pipe stub 73. The shank connection part 71 isconfigured for the integration into a cavity 77 of the control housing69. A lateral opening 79, through which the connection pipe stub 73extends outwards connects onto the cavity 77. A radial projection 81which can latch into correspondingly shaped latching openings 83 and 85of a radial contour 87 of the cavity 77 is shaped out on a side of theshank connection part 71 which by way of example lies opposite theconnection pipe stub 73. The latching openings 83 and 85 by way ofexample are offset to one another by 90° in a manner in which they runaround the shank connection axis 75. As a result, the shank connectionpart 71 can latch in two rotation positions which are distanced to oneanother by for example 90°. The lateral opening 79 can be shaped out ina manner corresponding to this.

The shank (not shown) is coupled to the shank connection part 71 in arotationally fixed manner so that the shank is also rotated by way ofrotating the shank connection part 71. By way of this, the direction ofthe bending of the distal bendable shank section can be influenced.Since on using a fluid channel 7, 53 which is merely defined by a shankjacket, several leads must be led outwards through the control housing69 without connecting the inner lumen of the fluid channel 7, 53 to theinner lumen of the control housing 69, a sealing means in the form of aseal device 89 is provided. This is shaped in a disc-like manner and isinsertable into a seal receiver 91 which in turn is fixedly connected tothe shank connection part 71.

The seal device 89 comprises four feed-throughs in the form of slots 93for leading through mechanical leads, for example pull wires. In thisexample precisely four slots 93 are shown, so that a shank according tothe FIGS. 2a and 2b can also be coupled to this seal device 89. Ifanother shank is to be used, then of course another number of slots 93can be realized. The shown slots 93 are based for example on radiallines which are shifted in parallel and which are offset to one anotherby 90° on a circular surface which is covered by the seal device 89. Theslots 93 pass through a peripheral surface 95 of the seal device 89 andby way of example project beyond a middle line which runsperpendicularly to the respective slot 93 and intersects a middle pointof the seal device. If the pull wires are configured as flat wires, thenthese can each run through a slot 93 between the shank and the controlhousing 69 and are hereby gently embraced by the material of the sealdevice 89.

In order to minimize a friction of the pull wires as much as possible,the seal device 89 is preferably manufactured of a closed-celled foammaterial. The dimensions of the seal device 89 in the non-inserted stateis preferably somewhat larger than the dimensions of the seal receiver91, so that the seal device 89 needs to be compressed somewhat oninsertion and constantly pushes into a relaxed, expanded posture.Hereby, all elements which are led through are sealingly embraced.

The seal device 89 further comprises further recesses 97, 99, 101 and103 which in accordance with the leads 11, 13, 15 and 19 can havedifferent dimensions. The seal device 89 has a largest recess 97 whichbelongs to the first working channel 15 which can extend along theextension axis 75 through the control housing 69 to the first proximalworking channel opening 39. Three further feed-throughs 99, 101 and 103in the form of recesses which serve for leading through the leads 11, 13and the smaller second working channel 19 are arranged adjacently to thelargest recess 97. The feed-though 103 which by way of example has thesmallest dimensions is suitable for instance for leading through thesmaller second working channel 19 with a dimension of significantlybelow 1 mm, for example 55 mm or less. The two other feed-throughs 99and 101 belong to the electrical leads 11, 13 which are connected to thedistal-side LED or to the picture sensor. The dimensions of the recesses97, 99, 101, 103 are each somewhat smaller than the cross section of theassociated led-through lead 11, 13, 15, and 19, in order to achieve asealing effect on the lead 11, 13, 15 and 19 at the outside. The sealdevice 89 is preferably an elastic cell foam block ofethylene-propylene-diene monomer (EPDM), so that the recesses 97, 99,101 and 103 on leading through the leads 11, 13, 15 and 19 accordinglyexpand and embrace these in a sealing manner.

The seal device 89 comprises a radial deepening 105 which in a mannercorresponding to a radial projection 107 is formed in a sleeve-likesection 109 of the sealing receiver 91. By way of this, the rotaryposition of the seal device 89 is always fixed, so that the seal device89 follows the rotation on rotating the shank connection part 71.

It is usefully to arrange guide means for guiding the pull wires in theseal receiver 91 and a cover 111 which is fastened thereto, so that theslots 93 of the seal device 89 are always flush with the pull wires onrotating the shank connection part 71. The seal device 89 is thereforeloaded exclusively by an axial force of the pull wires. In order tofurther achieve an ideal guiding of the pull wires, the cover 11 isarranged on the seal receiver 91 in a rotationally fixed manner. Forthis, a radially outer-lying tongue 113 which is aligned with a radiallyinner-lying deepening 115 of the cover 111 can be provided on thesleeve-like section 109.

As is represented in FIG. 3b , an additional sealing ring 117 whichseals the seal receiver 91 on the shank connection part 71 can beprovided. For this, the seal receiver 91 on a deepening 119 which isarranged opposite to the sleeve-like section 109 comprises a sealingsurface which can be brought to abut with the sealing ring 117 and anannular surface 121 of the shank connection part 71. The rinsing fluidwhich flows into the shank connection part 71 via the rinsing channelcannot proximally pass the seal device 89 and flows away radially viathe connection pipe stub 73.

A further aspect of the endoscopic instrument is shown in FIGS. 4a and4b . A fiber optic 123 which in particular is a laser fiber optic in theform of an individual fiber and has an exemplary diameter of 0.45 mm isrepresented in FIG. 4a . This diameter can preferably include aprotective layer of the fiber optic 123, wherein the light-leading corediameter can be for example only 0.272 mm. Of course, the fiber optic123 can also have an even smaller or a somewhat larger diameter. Thefiber optic 123 comprises a light exit end 125 which for optimalradiation characteristics runs in a sharp-edged as possible manner andperpendicularly to the extension axis of the fiber optic 123. However,the pushing of such a fiber optic 123 through a working channel 127which for instance has a diameter of 1.2 mm or more entailsdifficulties. The sharp-edged light exit end 125 could jam with theinner wall 129 of the working channel 127 on being pushed through thisand could prevent the pushing-through or the fiber optic could 123 evenkink. Furthermore, the wall 129 could also be destroyed on jamming ifthe light exit end 125 bores into the inner wall 129.

In order to prevent this, as is represented in FIG. 4b , an alternativeworking channel 131 as a second, smaller working channel 19 is providedfor the fiber optic 123, and this at least in a bendable section has aninner diameter of only a little more than the diameter of the fiberoptic 123 (here 0.45 mm) and by way of example is 0.55 mm. The fiberoptic 123 at its light exit end 125 only experiences a very small angleof engagement to an inner wall 133 of the working channel 133, so that ajamming is reliably prevented.

The mentioned diameters in the bendable section are merely to beunderstood as example. The inner diameter of the working channel 131 forleading through the fiber optic 123, at least in the bendable sectionshould have an inner diameter which does not exceed the outer diameterof the fiber optic 123 by too much. The difference between the twodiameters in the bendable section should not be too large sinceotherwise there is the danger of jamming and/or damage of the workingchannel 131. It has been found that a diameter difference in thebendable section of maximally 30% can prevent the damaging of theworking channel 131. The inner diameter of the working channel 131should therefore exceed the outer diameter of the fiber optic 123 at themost by 30% at least in the bendable section, which is the case with thementioned exemplary diameters.

A further aspect for realizing an endoscopic instrument 134 is shown inFIGS. 5 to 6 c. FIGS. 6a to 6c show a handling device 135, onto which aproximal end 138 of a shank 137 is connected. This comprises a distalend 139 which in the plane of the drawing at the left is represented ina somewhat enlarged manner and by way of example comprises a firstdistal working channel opening 140. A proximal fluid channel opening 142as well as an electrical connecting cable 146 is arranged on a sidewhich is at the bottom in the plane of the drawing, wherein a rinsingfluid or the like can exit out of the proximal fluid channel opening142. Here, a separate fluid inlet 148, through which the first workingchannel 15 can be rinsed with rinsing fluid is arranged on the upperside. Of course, the shank 137 can likewise comprise a distal bendableshank section which is provided with slots as is represented in thepreceding figures. It is generally advantageous to configuration theshank in a jointlessly bendable manner towards the distal end 139.

A first limb 141 and a second limb 143 are provided in a Y-arrangementat a proximal end of the handling device 135, between which limbs acontact surface 145 for applying a ball of the thumb of a hand isprovided. By way of example, a second proximal working channel opening144 is provided on the second limb 143. The alignment of the two limbs141 and 143 to one another as well as the dimensioning of the contactsurface 145 are selected such that on gripping the handling device 135,the ball of the thumb bears on the contact surface 145 in a manner suchthat the handling device 135 forms a direct extension of a lower arm ofthe user. The user can consequently very comfortably rotate the handlingdevice 135 exclusively by way of supination and pronation of the lowerarm about the longitudinal axis of the shank 137, without having tocarry out a more complex arm movement. In particular, this is not thecase with conventional pistol-like handling devices.

An upper trigger 147 and a lower trigger 149 follow distally on twosides of the handling device 135 which are opposite one another, saidtriggers being able to be actuated by two fingers of the hand by way ofproximal pulling and each being connected to a distally running pullwire. As in the embodiment example in FIG. 1, the upper trigger 147 andthe lower trigger 149 could also be coupled to one another, so that bothtriggers 147 and 149 execute opposite movements. It is conceivable for aguide roller to be present between the triggers 147 and 149, aroundwhich guide roller mentioned pull wires configured as a section of acommon pull wire are led. However, a cam disc which is coupled to bothtriggers 147 and 149 as well as a separate pull wire would also beconceivable. An arresting device 151 could be provided for arresting amomentary position of the guide roller or of the individual pull wires.In the represented case, the arresting device 151 is configured as aknurled screw which for example projects into a cam disc and is clampedonto the outer surface of the handling device 135 by way of tightening.

By way of example, a working channel inlet 153 is located on the firstlimb 141 according to a further aspect of this disclosure, as part of aLuer lock connection, on which working channel inlet a first closurethread 153 is proximally arranged. A shank tool in the form of a capturebasket insert is inserted into the instrument 1 through the workingchannel inlet 153 and is connected. The capture basket insert comprisesa connection element 157 which is connected via a second closure thread159 which is shaped in a manner corresponding to the first closurethread 155. A first rotatable receiving part 161 which is connected to atube 163 as a jacket element of the capture basket insert is mounted onthe connection element 157 of the capture basket insert. The jacketelement 163 of the capture basket insert extends through the firstworking channel 15 through the shank 3. The first receiving part 161comprises a first displacing section 165 which is provided with aperipheral-side detent 167. This permits the latching in differentpositions in an opening contour 169 of the connection element 157. Byway of displacing the first receiving part 161 in the distal directionalong the first displacing section 165, consequently the tube 163 can bedistally displaced in the first working channel 15. A first shoulder 171in the form of a peripheral collar which has a peripheral knurling 173is arranged on an end of the first displacing section 165 which isopposite to the connection element 157. By way of this, the firstreceiving part 161 can be gripped and rotated. The peripheral-sidedetent 167 is therefore preferably configured in the form of grooveswhich are arranged parallel to one another and which have a roundedprofile cross section. A manual displacing in the distal or proximaldirection can lead to the release and the reaching of a latching.

A second receiving part 177 is arranged in an inner lumen 175 of thefirst receiving part 161. This comprises a second displacing region 179,with which the relative position of the second receiving part 177 to thefirst receiving part 161 can be adjusted. The second receiving part 177is simultaneously connected to the first receiving part 161 via arotationally fixed, displaceable connection. The second receiving part177 therefore directly follows the movement of the first receiving part161. The second receiving part 177 is connected to a pull wire 181 whichextends through the jacket element of the capture basket insert which isconfigured as a flexible tube 163. The second receiving part 177 furtherat an end of the second displacing section 179 which is away from thefirst receiving part 161 comprises a second shoulder 183 in the form ofa peripheral collar which is likewise provided with a knurling 185. Auser can consequently easily grip and rotate the receiving parts 161 and177. On account of the fixed connection between the components, theflexible tube 163 and the pull wire 181 are also rotated. The secondreceiving part 177 likewise comprises a detent 187 which can latch withan opening contour 189 of the first receiving part 161. The position ofthe second receiving part 17 can consequently always be set in a fixedmanner with respect to the first receiving part 161.

As is represented in the FIGS. 6a to 6c , on account of thisconfiguration a particular advantageous construction of a capture basket191 can be realized, said capture basket being arranged in the jacketelement 163 of the capture basket inert and being protected by this. Thecapture basket 191 is configured in such an elastic manner that it canbe completely retracted into the jacket element 163 and can be pushedout of this by way of a distal movement, where it expands to its fullsize. A kidney stone or the like can be gripped by way of a targetedmovement of the capture basket 191, wherein the gripping is effected byway of a proximal pulling of the pull wire 181 and the capture basket iscompressed again by way of this. FIG. 6a shows the first receiving part161 and the second receiving part 177 in the proximal position. Thismeans that an actuation grip 193 is pulled out of the handling device135 as far as possible.

As is evident in the enlarged representation of the distal tip 139 ofthe shank 137, the jacket element 163 of the capture basket insert doesnot extend beyond the distal shank tip 139. By way of moving the firstreceiving part 161 over the complete first displacement path 165 in thedistal direction, so that the first shoulder 71 lies on the connectiondevice 157 in a flush manner, the flexible tube 163 projects out of thedistal shank tip 139 for example by about 5 mm. By way of pushing in thesecond receiving part 177 in the distal direction, the capture basket191 can be pushed out of the flexible tube 163, so that it unfolds. 5 mmcan be suitable as a displacement path for the flexible tube 163. It isconceivable to provide a significantly greater length, for example 20mm, for the unfolding of the capture basket 191.

The particular advantage of this arrangement with the distallydisplaceable jacket element 163 of the capture basket insert and therotatable connection lies in the fact that the capture basket 191 by wayof acting upon the handle 193 can be easily rotated in all unfoldingstates. Simultaneously, by way of actuating the handle 193, an advancingand unfolding of the capture basket 191 by the hand which indeed doesnot grip the handling device 135 is permitted. If an object is grippedby the wire capture basket 191, then the object can be firmly held byway of retracting the second receiving part 177. On account of thedetent 187, the object remains caught, without it having to be activelyfirmly held. The capture basket can accordingly be very easily actuatedby an individual user, and a second user, with whom one must intensivelycommunicate during the operation, is not necessary.

On account of the second, smaller working channel 19, a laser fiberoptic 123 can be led onto the distal shank tip 17 parallel to thecapture basket insert in the first working channel 15, in order forexample to be able to smash a kidney stone by way of laser light. Thesecond, smaller working channel 19 ends at the proximal side on thesecond proximal working channel opening 144 on the second limb 143 ofthe handling device 135.

In FIGS. 7a -f, the shank 3, in particular the bendable shank section 9,49 of the shank 3 and the distal shank end 17, 51, 139 are shown in moredetail. A distal end sleeve 195 is not shown in FIGS. 7a -c, and this isshown in more detail in FIGS. 7d -f. The distal shank end 17, 51, 139comprises a connection sleeve 197, by way of which the end sleeve 195 ispositively fastened to the shaft 3 in a rotationally fixed manner (seeFIG. 7f ). The end sleeve 195 comprises a recess 199 and the connectionsleeve 197 an indentation 201 which is shaped in a manner whichcorrespondingly matches the recess 199, by which means a rotationallyfixed positive connection between the end sleeve 195 and the connectionsleeve 197 is achieved.

The connection sleeve 197 in an overlapping section overlaps the distalend of the slotted bendable shank section 9, 49. Lateral rinsingopenings 203 here in the form of eight radial through-bores which aredistributed circumferentially are present in the overlapping section.Since the slots 33, 55, 64 of the bendable shank section 9, 49 are heresurrounded by a protective flexible tube 205 (see FIG. 7f , not shown inFIG. 7a-e ), the rinsing openings 203 serve as a distal rinsing outletor rinsing inlet of the fluid channel 7, 53. The thickness of theconnection sleeve 197 corresponds roughly to the thickness of theprotective sleeve 205, so that the radial outer surfaces of theprotective flexible tube 205, connecting sleeve 197 and end sleeve 195when abutting one another are flush with one another without edges (seeFIG. 7f ).

The pull wires 57, 59, 65, 67 which in a manner lying diametricallyopposite (here: at the top 57,65 and at the bottom 59, 67) extendthrough the shank 3 on the shank inner surface in order to be able tobend the bendable shank section 9, 49 jointlessly upwards or downwardsare shown in FIG. 7b . For this, the slots 33, 55, 64 are configured ina wedge-like manner, so that the clear width of the slots 33, 55, 64 islargest at the middle where the pull wires 57, 59, 65, 67 run, and taperin the circumferential direction towards the ends. The ends of the slots33, 55, 64 comprise round recesses, in order, given the bending of theshank material, to reduce the stresses and to reduce material tears orthe risk of plastic deformations of the shank material. The jointlessbending of the shank section 9, 49 should be effected by way of anelastic as possible deformation of the slotted shank material which hasa restoring effect into the straight shank shape.

The arrangement of a light source in the form of an LED 207, anobjective 209 with a picture sensor lying therebehind, the first distalworking channel opening 18, 52, 140 of the first working channel 15 anda second distal working channel opening 211 of the second workingchannel 19 in the distal end sleeve 195 are shown in a front elevationin FIG. 7d . The extremely small size conditions are to be noted. Theouter diameter of the distal end sleeve 195 can be 3 mm or less. The LED207 can be 0.55 mm wide and the picture sensor 209 less than 1 mm wide.The first distal working channel opening 18, 52, 140 can have an innerdiameter of 1.2 mm or less and the second distal working channel opening211 an inner diameter of 0.55 mm or less. The distal-side lightoutcoupling of a laser fiber optic 123, said fiber optic being pushedthrough the second working channel 19, can be placed on the seconddistal working channel opening 211. The tool head of a shank tool, forexample a capture basket insert or a forceps or scissor instrument,these being able to be pushed through the first working channel 15, canbe led out of the first distal working channel opening 18, 52, 140. Thefirst working channel 15 can moreover be used as a feed conduit ordischarge conduit of rinsing fluid which is accordingly led away or fedvia the lateral rinsing openings 203 and the fluid channel 7, 53. A feedof clear rinsing fluid via the first working channel 15 and a dischargevia the lateral rinsing openings 203 and the fluid channel 7, 53 ispreferred, in order to obtain a clear distal view.

It is shown in FIG. 7e that the distal end sleeve 195 is beveled at thefront side, so that in particular the first distal working channelopening 18, 52, 140 runs at an angle to the longitudinal axis of theshank 3. Preferably, the second distal working channel opening 211 isalso beveled (not visible in FIG. 7e ). The respective distal openingsin the end sleeve 195 for the LED 207 and the objective 209 can also bebeveled, in order to improve the respective illumination or the viewingangle. The one or more bevelings of the distal shank tip 17, 51, 139have the further advantages that the distal shank tip 17, 51, 139 can beled more simply through a ureter or kidney tube or a trocar or catheter.

FIGS. 8a-e show the single-part metallic tubular main body of the shank3, 47 which comprises the rinsing openings 203, the slots 33, 55, 64 andthe proximal fluid channel opening 45, 73, 142. The bendable shanksection 9, 49 with the slots 33, 55, 64 preferably comprises at leasttwo sub-sections Y, Z, wherein the axial distances between the slots 33,55, 64 are different in the sub-sections X, Z. Preferably, the distancesbetween the slots 33, 55, 64 in a first sub-section Y is smaller than ina second sub-section Z, wherein the first sub-section Y is arrangeddistally of the second sub-section Z. By way of this, a greatercurvature can be achieved in the first sub-section Y than in the secondsub-section Z. Furthermore, the first sub-section Y is less flexurallyrigid than the sub-section Z, so that the bendable shank section 9, 49rolls in given bending from the distal tip 17, 51, 139. By way of this,a particularly good mobility of the distal tip 17, 51, 139 and aparticularly large bending range of up to 300° can be achieved in asmall space. As is shown in FIG. 8c,d shows, the clear width of theslots 33, 55, 64 in the first sub-section Y can be larger than in thesecond sub-section Z. This can likewise assist the bending ability ofthe shank section 9, 49 which is improved in the distal direction. Theclear width and/or the slot distances can gradually vary within and/orbetween the sub-sections Y, Z, so that the sub-sections Y, Z can runinto one another. The sub-sections Y, Z can be arranged adjacently toone another or separately from one another.

FIGS. 9a,b show a further configuration of the Y-shaped handling device5, 135. The instrument which is shown in FIG. 9b can be inexpensivelymanufactured as a sterilized disposable product which is preassembled onthe part of the factory. Once again, it is emphasized how the distalshank tip 17, 51, 139 can be bent upwards or downwards by up to 300° byway of pulling the triggers 147, 149. FIG. 9c shows the distal shank tip17, 51, 139 in a perspective view with beveled working channel openings18, 52, 140, 144. FIG. 9d illustrates how a shank tool in the exemplaryform of a forceps instrument 213 can be pushed through the first workingchannel 15 and is axially positionable given a bent shank section 9, 49.

In inner workings of the Y-shaped handling device 5, 135 is shown inmore detail in a longitudinal section in FIGS. 10 a,b. FIG. 10b hereinshows an enlarged detail X. FIG. 10c shows an enlarged representation ofthe seal device 89 in the form of a cell foam block which is seated inthe seal receiver 91 and proximally seals the fluid channel 7, 53. Theseal device 89 comprises recesses 97, 99, 101 and 103 for leadingthrough the leads 11, 13, 15 and 19 which in accordance with the leads11, 13, 145 and 19 have different dimensions. The seal device 89 has alargest recess 97 which belongs to the first working channel 15 whichcan extend along the extension axis 75 through the control housing 69 tothe proximal working channel opening 39. Three further feed-throughs 99,101 and 103 in the form of recesses are arranged adjacently to thelargest recess 97 and serve for leading through the leads 11, 13 and thesmaller second working channel 19. The feed-through 103 which by way ofexample has the smallest dimensions, is suitable for instance forleading through the smaller second working channel 19 with a dimensionof significantly below 1 mm, for example 0.55 mm or less. The two otherfeed-throughs 99 and 101 belong to the electrical leads 11, 13 which areconnected to the distal-side LED 207 and the picture sensor 209respectively. The dimensions of the recesses 97, 99, 101 and 103 areeach somewhat smaller than the cross section of the associatedled-through lead 11, 13, 15 and 19, in order to achieve a sealing effecton the lead 11, 13, 15, and 19 at the outside. The seal device 89 ispreferably configured as an elastic cell foam block ofethylene-propylene-diene monomer (EPDM), so that the recesses 97, 99,101 and 103 accordingly expand on leading through the leads 11, 13, 15and 19 and embrace these in a sealing manner. The two slots 93 which arearranged offset to one another serve for the sealed leading-through ofthe two pull cables 57, 59. The radial deepening 105 serves for therotation lock of the seal device 89.

It is further illustrated in FIG. 10a how the first working channel 15can be supplied with rinsing fluid via the upper-side fluid inlet 148,so that the first working channel 15 can serve as a feed channel ofrinsing fluid. For this, a T-connection piece 215 is arranged in thefirst working channel 15 within the handling device 5 and is connectedto the upper-side fluid inlet 148 via a rinsing conduit 217. Herewith, adrip which is hung up or a pump can be connected to the fluid inlet 148,so that rinsing fluid runs through the rinsing conduit 217 into thefirst working channel 15.

It is to be noted that the features of the previously describedembodiment examples can be arbitrarily combined with one another.

While specific embodiments of the invention have been shown anddescribed in detail to illustrate the application of the principles ofthe invention, it will be understood that the invention may be embodiedotherwise without departing from such principles.

LIST OF REFERENCE CHARACTERS

-   1 endoscopic instrument-   3 shank-   4 proximal end of the shank-   5 handling device-   7 fluid channel-   9 bendable shank section-   11 first optical or electrical lead-   13 second optical or electrical lead-   15 first working channel-   17 distal end/distal tip of the shank-   18. first distal working channel opening-   19 second working channel-   21 flow lines/backflow fluid-   23 housing-   25 grip opening-   27 contact surface-   29 lower trigger/operating lever-   31 upper trigger/operating lever-   33 slot-   35 peripheral surface-   37 upper side of the handling device-   39 proximal end-   41 lower side of the handling device-   43 a, 43 b second proximal working channel opening-   45 proximal fluid channel opening-   47 shank-   49 bendable shank section-   51 distal end of the shank-   52 first distal working channel opening-   53 fluid channel-   55 first slot-   57 mechanical lead (pull wire)-   59 mechanical lead (pull wire)-   61 first region-   63 second region-   64 second slot-   65 mechanical lead (pull wire)-   67 mechanical lead (pull wire)-   69 control housing-   71 shank connection part-   73 proximal fluid channel opening/connection pipe stub-   75 shank connection axis-   77 cavity-   79 lateral opening-   81 radial projection-   83 latching opening-   85 latching opening-   87 radial contour-   89 seal device-   91 seal receiver-   93 slot/feed-through-   95 peripheral surface-   97 feed-through-   99 feed-through-   101 feed-through-   103 feed-through-   105 radial deepening-   107 radial projection-   109 sleeve-like section-   111 cover-   113 radially outer-lying tongue-   115 radially inner-lying deepening-   117 sealing ring-   119 deepening-   121 annular surface-   123 fiber optic-   125 light exit end-   127 conventional working channel-   129 inner wall-   131 working channel-   133 inner wall-   134 endoscopic instrument-   135 handling device-   137 shank-   138 proximal end of the shank-   139 distal end of the shank-   140 first distal working channel opening-   141 first limb-   142 proximal fluid channel opening-   143 second limb-   144 proximal second working channel opening-   145 contact surface-   146 electrical connection cable-   147 upper trigger/operating lever-   148 fluid inlet-   149 lower trigger/operating lever-   151 arresting device-   153 working channel inlet-   155 first closure thread-   157 connection element-   159 second closure thread-   161 first receiving part-   163 jacket element of the shank tool-   165 first displacing section-   167 detent-   169 opening contour-   171 first shoulder/collar-   173 knurling-   175 inner lumen-   177 second receiving part-   179 second displacing section-   181 pull wire-   183 second shoulder/collar-   185 knurling-   187 detent-   189 opening contour-   191 capture basket-   193 actuation grip-   195 end sleeve-   197 connection sleeve-   199 recess-   201 indentation-   203 rinsing openings-   205 protective sleeve-   207 LED-   209 objective-   211 second distal working channel opening-   213 forceps instrument-   215 T-Connection piece-   217 fluid conduit-   ß angle (lateral offset)

1. An endoscopic instrument for inserting into a body of a patient,wherein the instrument comprises: a tubular shank which is coupled orcan be coupled to a handling device; and a working channel, wherein ashank tool can be led through the working channel, and the workingchannel comprises a proximal working channel opening for inserting theshank tool, and a fluid inlet which is separate from the proximalworking channel opening.
 2. An endoscopic instrument according to claim1, wherein the proximal working channel opening and the proximal fluidinlet are connected to the working channel via a T-connection piece inthe handling device.
 3. An endoscopic instrument according to claim 1,further comprising at least two leads which run through the shank,wherein a fluid channel, which individually directly surrounds the atleast two leads which run through the shank, is formed in the shank. 4.An endoscopic instrument according to claim 3, wherein the fluid channelis configured as a discharge channel of rinsing fluid which is fed to adistal shank end via the fluid inlet and the working channel.
 5. Anendoscopic instrument according to claim 3, wherein the fluid channelcomprises a distal fluid channel opening and a proximal fluid channelopening, wherein the proximal fluid channel opening is arrangedlaterally on the shank and is subjectable to fluid vacuum.
 6. Anendoscopic instrument according to claim 1, further comprising: aplurality of leads which run through the shank; and a sealing meanswhich forms a proximal end of the fluid channel and comprisesfeed-throughs for the leads.
 7. An endoscopic instrument according toclaim 1, further comprising a handling device, wherein the handlingdevice is fixedly connected or is releasably connectable to a proximalend of the shank.
 8. An endoscopic instrument according to claim 1,wherein the shank at least in a shank section is elastically jointlesslybendable by more than 270°.
 9. An endoscopic instrument according toclaim 1, wherein the instrument or at least the shank is configured as adisposable article for disposal after a single use.
 10. An endoscopicinstrument according to claim 1, further comprising a plurality of leadswhich run through a shank interior, wherein a cross-sectional area ofthe fluid channel corresponds to a cross-sectional area of a shankinterior which is formed by the shank, minus a sum of thecross-sectional areas of all leads which run through the shank interior.11. An endoscopic instrument according to claim 1, wherein the shank ina distally bendable shank section comprises a plurality of slots.
 12. Anendoscopic instrument according to claim 11, wherein the slots onlyextend over a part of the shank periphery in the circumferentialdirection.
 13. An endoscopic instrument according to claim 11, whereinthe slots are arranged axially to one another such that the slotsalternately lie on a first lateral side of the shank and a secondlateral side of the shank which lies diametrically opposite the first.14. An endoscopic instrument according to claim 11, wherein the slotsare configured as a distal fluid channel opening for the fluid channeland locally increase a flexibility of the shank for the bending of adistal shank end.
 15. An endoscopic instrument according to claim 1,wherein the working channel is a first working channel, and furthercomprising a second working channel which runs through the shank andwhich is directly surrounded by the fluid channel.
 16. An endoscopicinstrument according to claim 15, wherein the first and/or secondworking channel is configured to selectively lead through a laser fibreoptic, the capture basket or a Dormia loop.
 17. An endoscopic instrumentaccording to claim 15, wherein the first working channel serves as afeed channel with a flow direction which runs opposite with respect tothe fluid channel.
 18. An endoscopic instrument according to claim 15,wherein the first and/or second working channel runs axially through asealed proximal end of the fluid channel.
 19. An endoscopic instrumentaccording to claim 15, wherein the first and/or second working channelcomprises a distal working channel opening and a proximal workingchannel opening.
 20. An endoscopic instrument according to claim 19,wherein the respective proximal working channel opening is arrangedproximally of the proximal end of the fluid channel.
 21. An endoscopicinstrument according to claim 19, wherein the respective distal workingchannel opening is arranged distally of a distal fluid channel openingof the fluid channel.
 22. An endoscopic instrument according to claim19, further comprising a handling device, wherein the handling device isfixedly connected or releasably connectable to a proximal end of theshank, wherein the respective proximal working channel opening is formedby the handling device.
 23. An endoscopic instrument according to claim19, wherein a cross section of the respective distal working channelopening is smaller than a cross section of the associated workingchannel.
 24. An endoscopic instrument according to claim 23, wherein thecross section of the respective working channel tapers towards therespective distal working channel opening.
 25. An endoscopic instrumentaccording to claim 1, wherein a through-flow direction and/or athrough-flow rate through the fluid channel is selectable or can be set.26. An endoscopic instrument according to claim 1, wherein a distalshank end is controllably jointlessly bendable in a controllable manner.